Socioeconomic factors hurt children's hospital readmissions

Critics of the Centers for Medicare & Medicaid Services' readmissions penalties have long argued the program unfairly punishes hospitals for factors outside their control, and new research published in JAMA Pediatrics supports that claim.

University of Colorado School of Medicine researchers, led by Marion R. Sills, M.D., analyzed 2013 data for 179,400 hospital dischargesfrom 43 independent pediatric hospitals. They found 22 hospitals were subject to 15-day readmission penalties and 23 received 30-day readmission penalties. However, after adjusting for socioeconomic factors, two hospitals were no longer penalized for 15-day readmissions and three were no longer penalized for 30-day readmissions. After the adjustment, one hospital was newly penalized for 15-day readmissions and two were newly penalized for 30-day readmissions.

"The financial effect of P4P [pay for performance] penalties is substantial, can worsen the financial challenges already facing safety-net hospitals and can lead to unintended consequences such as hospital closure," according to Sills and her team.

The results indicate that methodologies for financial penalties do not take external factors into consideration, Sill said in a statement.

"Studies like ours show that patients who are poorer or are minorities are readmitted at higher rates than other patients, which raises concern that the readmissions penalties punish hospitals for the type of patients that they serve, rather than purely for the quality of care they provide," she said.

The results will provide additional fuel for those who argue in favor of risk-adjusting healthcare outcomes for social determinants of health, according to a commentary accompanying the study abstract. These could include familial aspects such as family income or parent education levels, as well as broader environmental factors like lead exposure or local crime rates. Research published in January, however, suggests that higher readmissions at safety-net providers may be due to gaps in post-discharge care.